Healthcare Provider Details

I. General information

NPI: 1891247128
Provider Name (Legal Business Name): ASHLEY RASA WHNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 MURRAY DR
STOCKTON CA
95210-3339
US

IV. Provider business mailing address

7210 MURRAY DR
STOCKTON CA
95210-3339
US

V. Phone/Fax

Practice location:
  • Phone: 209-373-2800
  • Fax: 209-373-2878
Mailing address:
  • Phone: 209-373-2800
  • Fax: 209-373-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95005340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: